Author Archives: Reeve Conover

CIGNA Opioid-related formulary changes

A communication is being sent to impacted Cigna clients in the next few days to announce updates on our July 2018 formulary changes.

Pharmacy costs are currently the number one driver of client expenses under both pharmacy and medical benefits.1 At the same time, opioid abuse continues to be a U.S. public health crisis according to the Department of Health and Human Services.2 To address these issues, Cigna’s formulary strategy will be updated to maintain high clinical value while continuing to use a low net drug cost approach to manage coverage for costly branded drugs. At the same time, we will build upon current steps to administer prescription drug coverage in a manner that promotes safe opioid use.

Effective July 2018* our formularies will be updated and Cigna will implement tighter utilization management around the use of opioids.

Customers (employees and dependents) affected by these changes (estimated to be less than 1% of customers3) will also receive a letter from Cigna in early April informing them of the change. Depending on the change, the letters contain steps to work with their doctor to find covered alternatives, prescribe lower quantity levels or apply for drug coverage approval through Cigna’s prior authorization process.

  • Click here to read a summary of Cigna’s July 2018 formulary changes.

Click the following links to view detailed (drug specific) changes for each of Cigna’s formularies. Clients will be sent the above summary and one of the flyers below based on their formulary:

There is still a penalty for not having insurance…

Just a reminder that, while recent legislation did eliminate the penalty, it does not take affect until 2019.

Employer penalties in 2018 are at elast $2320 after the first tirty employees.

The individual Penalty is

  • $695 for each adult and $347.50 for each child, up to $2,085 per family, or
  • 2.5% of family income above the federal tax filing threshold, which the Kaiser Foundation calculator estimates is $10,650 for an average single filer

or $21,300 for the average family who file jointly in 2018

Why LI Hospital Mergers make it harder…

A recent article in Newsday points out that there is only 1 independent hospital left on the island – Brookhaven Medical Center, now know as the Long Island Medical Center.

“Hospitals are combining nationwide. There were 78 hospital deals in the United States in 2017, in which 216 hospitals, with a total of 27,386 beds, were acquired, said Lisa Phillips, editor of HealthCareMandA.com, a publication that tracks health care mergers for health care consultant Irving Levin Associates in Norwalk, Connecticut…   In the New York metropolitan area, New Hyde Park-based Northwell Health, the most aggressive acquirer on Long Island, has expanded its network into Brooklyn, Westchester County and eastern Long Island by taking over hospitals. It has added four hospitals in the past 3 1⁄2 years.”

This has made it hard on patients – especially those on ObamaCare individual policies – to find insurance that covers their doctors.  Northwell does not have a relationship with Oscar Health Plans, the most affordable of the options.  Some hospitals simply refuse to accept the reimbursement rates of the individual plans as well.   NYU Hospitals don’t have relationships with Healthfirst either.  If you live in Nassau County, you are more or less forced into expensive options – Empire and Emblem.

I believe it likely that we will see some changes to this during the year, but only time will tell.  And any midyear changes don’t help you this year, since you cannot change until January 1…

Oxford Health Plans’ Cancer Support Program

Remind Oxford members to call the Cancer Support Program;
We’re here for them.

Dealing with a diagnosis of cancer can be overwhelming. It’s common to be faced with more questions than answers, and uncertainty about where to turn for help.

That’s why we offer the Cancer Support Program, a single source for Oxford members with cancer and their caregivers (physicians, family members, hospice, etc.) to get cancer information, support and guidance in navigating the health care system.

The attached flier offers more details about the Cancer Support Program. Please provide it to your Oxford clients so they can share it with their employees as a reminder of the program.

Members can opt-in.
The Cancer Support Program is available at no additional charge as part of Oxford members’ medical benefit plans. Participation is optional.

We may also identify members for the program through our internal processes and programs, such as provider notifications, and pharmacy and medical claims analysis, as well as through our nurse line (Oxford On-Call®) and Customer Service interactions. A member can also be referred to the program by his or her provider.

Compassionate care from an experienced team. 
Program nurses specializing in oncology serve as one contact for members in the program, helping them make more informed decisions about their cancer care. They can also offer information about oncology centers of excellence and specialists within the plan network. And our nurses are supported by an entire team of cancer specialists.

Through comprehensive case management services, members can receive one-on-one help with a range of cancer-related issues, while employers may save on cancer-related medical costs. Additional support from social workers offers members and their loved ones help with family, work, financial and other needs.

An integrative approach to close gaps in care. 
Members engaged in the program can get support from their experienced cancer nurse through education and proactive, targeted interventions addressing symptoms and side effects. Our dedicated nurses work to help members remain productive while focusing on getting and staying healthy.

More information.
For more information about the Cancer Support Program, please contact your Oxford representative.

Are Your Beneficiary Designations Up to Date?


Who should inherit your IRA or 401(k)? See that they do

Provided by Reeve Conover

 

Here’s a simple financial question: who is the beneficiary of your IRA? How about your 401(k) or annuity? You may be saying, “I’m not sure.” It is smart to periodically review your beneficiary designations.

Your choices may need to change with the times. When did you open your first IRA? When did you buy your life insurance policy? Was it back in the Nineties? Are you still living in the same home and working at the same job as you did back then? Have your priorities changed?

While your beneficiary choices may seem obvious and rock-solid when you initially make them, time has a way of altering things. In a stretch of five or ten years, some major changes can occur in your life and may warrant changes in your beneficiary decisions.

In fact, you might want to review them annually. Here’s why: companies frequently change custodians when it comes to retirement plans and insurance policies. When a new custodian comes on board, a beneficiary designation can get lost in the paper shuffle. (It has happened.) If you don’t have a designated beneficiary on your retirement accounts, those assets may go to the “default” beneficiaries when you pass away, which might throw a wrench into your estate planning. An example: under ERISA, your spouse receives your 401(k) assets if you pass away. Your spouse must waive that privilege in writing for those assets to go to your children instead.1

How your choices affect your loved ones. The beneficiary of your IRA, annuity, 401(k), or life insurance policy may be your spouse, your child, maybe another loved one, or maybe even an institution. Naming a beneficiary helps to keep these assets out of probate when you pass away.

Many people do not realize that beneficiary designations take priority over bequests made in a will or living trust. For example, if you long ago named a son or daughter who is now estranged from you as the beneficiary of your life insurance policy, he or she will receive the death benefit when you die, regardless of what your will states.2

You may have even chosen the “smartest financial mind” in your family as your beneficiary, thinking that he or she has the knowledge to carry out your financial wishes in the event of your death. But what if this person passes away before you do? What if you change your mind about the way you want your assets distributed and are unable to communicate your intentions in time? And what if he or she inherits tax problems as a result of receiving your assets?

How your choices affect your estate. If you are naming your spouse as your beneficiary, the tax consequences are less thorny. Assets you inherit from your spouse aren’t subject to estate tax, as long as you are a U.S. citizen.3

When the beneficiary isn’t your spouse, things get a little more complicated – for your estate and for your beneficiary’s estate. If you name, for example, your son or your sister as the beneficiary of your retirement plan assets, the amount of those assets will be included in the value of your taxable estate. (This might mean a higher estate tax bill for your heirs.) And the problem will persist: when your non-spouse beneficiary inherits those retirement plan assets, those assets become part of their taxable estate, and their heirs might face higher estate taxes. Your non-spouse heir might also have to take required income distributions from that retirement plan someday and pay the required taxes on that income.4

If you properly designate a charity or other 501(c)(3) non-profit organization as a beneficiary of your retirement account assets, the assets can pass to the charity without your estate being taxed, and the gift will be deductible for estate tax purposes.5

 

Reeve Conover may be reached at 843-800-8190 or reeve@reevewillknow.com

 

This material was prepared by MarketingPro, Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. This information has been derived from sources believed to be accurate. Please note – investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment.

 

«RepresentativeDisclosure»

 

Citations.

1 – forbes.com/sites/ashleaebeling/2018/01/08/five-retirement-housekeeping-moves-for-the-new-year/ [1/8/18]

2 – thebalance.com/why-beneficiary-designations-override-your-will-2388824 [8/28/17]

3 – nolo.com/legal-encyclopedia/estate-planning-when-you-re-married-noncitizen.html [2/4/18]

4 – corporate.findlaw.com/law-library/who-should-be-the-beneficiary-of-your-qualified-retirement-plan.html [2/4/18]

5 – ameriprise.com/research-market-insights/financial-articles/insurance-estate-planning/charitable-giving/ [2/4/18]

 

 

 

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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